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VBAC
Thoughts on finding a new provider/weighing options
in VBAC
(excuse formatting on phone). My annual exam is next month. I would like to have my future vbac supportive team in place by then rather than go back to my old O.B. There is a VBAC supportive hospital I would switch to and I was referred to a VBAC supportive O.B. by ICAN. One hesitation with this O.B. Is that she belongs to a group with 12 other O.B.s but it is really is the most supportive O.B. Group in the area. I still feel really gun shy about O.B.s and hospitals. Option 2 is a birthing center that is now accepting VBACs on a case-by-case basis. I would have to pay for my hospital records as well as the consult and could be turned down. I'm not 100% sure I could go through with a non hospital attempt but feel like I should explore my options before ruling it out. A hospital birth with a CNM is not a option in the area. Basically, I'm not 100% comfortable with either option and don't know how to move beyond this point. If you struggled with these feelings as well any advice is appreciated. The doubts expressed about each option are just a few of the concerns I am wrestling with.
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Re: Thoughts on finding a new provider/weighing options
I'm not 100% comfortable with any of my options for this pregnancy. I think a lot of that is actually my fears about giving birth again and my left-over feelings from my c/s manifesting themselves. So I've tried to think about what makes me uncomfortable about each option and then go with the option that will give me the least amount of anxiety.
How much would you have to pay for the records/consult with the birth center? I think if they accept you, that would probably be your best option for a vaginal birth because midwives and birth centers generally have much lower c/s rates and fewer interventions overall. But in the end it really depends on what you are most comfortable with. If the cost is not too much, I think you should consult with the birth center and then you can weigh both options.
Oh and there is one study on VBAC in freestanding birth centers. The authors conclude that VBACs should be done in hospitals but that is based on level III evidence, which is the lowest level.
Anyway, I can only access the abstract but if you look at their numbers, they show very good outcomes for birth center VBACs--as good as the outcomes you see in studies of hospital VBACs.
https://journals.lww.com/greenjournal/Abstract/2004/11000/Results_of_the_National_Study_of_Vaginal_Birth.9.aspx
DS2 - Oct 2010 (my VBAC baby!)
I wrestled with this same issue. I started "shopping" for a new provider before I became pregnant because I was very anxious. I interviewed one hospital-based OB group with a good track record on VBAC and two CNM run birthing centers. One midwife was very brusque and doubtful of me over the phone (I later learned that she has a military background --- so that helped me understand why she was so, well, militaristic in her questioning of my past experience...nothing against military folks, just her personality didn't mesh well with mine). She shot me down - I guess she wasn't comfortable with VBAC in her birth center. However, the OB group I saw thought I was an excellent candidate and so did the other birth center. I picked the birth center ultimately because I want less interventions and the hospital makes me feel very anxious. I realize I need a calmer environment so I can manage the emotional aspects of my next labor. I have a whole list of questions for the birth center I wrote out, because I was concerned about safety at first. If you want them, just let me know and I would be happy to send/c&p.
GL with your decision!
I will preface this by disclosing that I have chosen a homebirth, and would probably have done a birth center birth if my state allowed them for VBACs (and then maybe later changed to homebirth anyway hehe).
I would encourage you to consider what it is about a birth center birth that makes you uncomfortable. I'm not saying you should choose that route, but be certain of what makes you uneasy about it, and also find out if perhaps doing an open house at the BC (if you haven't already) would allow you to ask some questions. The hold ups you have could be addressed and leave you feeling quite comfortable about that option, or it may confirm that you do indeed want to be in the hospital.
The advantage of a midwife-attended out-of-hospital birth is gaining the presence and attentiveness of the midwife. She will know what to look for if a rupture begins to occur and can get you transferred for surgery. Most hospitals don't have an OR just ready and waiting - there is some delay. Midwives truly have the skill to stop emergencies from becoming emergencies, or if they can't do anything, they are very quick to transfer care and get the right care at the right time.
How far is the BC from the hospital? What is their transfer protocol, and rate of transfers (ie #)?
Having some personal expense with obtaining the medical records and having to relax a little on having everything set in order (I'm similar
) can be things worth accepting if it means being in the right place for your BEST chance at a VBAC, in the event that ends up being the birth center.
Consider what kind of environment YOU need to be supported all the way to the end to have a VBAC. What could cause you to falter in confidence? Do you feel completely safe at the hospital? Do you worry greatly about rupture? If so, do you feel that you have an accurate perspective on the risk of rupture? Once we realized how small the risk is, and what our view of childbirth is, and how out of hospital VBACs seem to have a higher success rate, it made sense to us to choose the path we have. Of course, that was only after DH became completely satisfied with the emergency measures and meds that the midwives have at their disposal to deal with hemorrhage, needs for O2, resuscitation, etc. If we didn't feel it was safe, we never would have transferred care from a hospital birth to a homebirth.